Pigmentation refers to the colouring of the skin, which is determined by a pigment called melanin. Melanin is produced by specialised cells called melanocytes and plays an important role in protecting the skin from ultraviolet (UV) radiation. When melanin production becomes uneven or excessive in certain areas, it results in patches or spots of discolouration on the skin surface. This is what most people refer to when they talk about a pigmentation concern.

Pigmentation changes can appear darker than the surrounding skin (hyperpigmentation) or lighter (hypopigmentation). The most commonly treated concern in a clinical setting is hyperpigmentation, where areas of skin appear noticeably darker.

There are several distinct types of pigmentation, each with different causes and characteristics:

Sun Damage and Solar Lentigines (Sun Spots) Also referred to as age spots or liver spots, solar lentigines are flat, brown or tan patches that develop on areas of the skin regularly exposed to the sun, most commonly the face, hands, shoulders, and chest. They are caused by cumulative UV exposure over time and become more common with age.

Melasma Melasma appears as symmetrical patches of brown or grey-brown discolouration, most often across the cheeks, forehead, upper lip, and chin. It is strongly associated with hormonal influences, including pregnancy, the oral contraceptive pill, and hormone replacement therapy, and is significantly worsened by sun exposure. Melasma can be one of the more complex pigmentation conditions to manage and often requires an ongoing maintenance approach.

Post-Inflammatory Hyperpigmentation (PIH) Post-inflammatory hyperpigmentation occurs as a response to skin injury or inflammation. Following acne, eczema, a cut, burn, or any procedure that disrupts the skin, the healing process can trigger excess melanin production, leaving a dark mark at the site. PIH is more commonly seen in medium to darker skin tones, though it can affect any skin type.

Freckles (Ephelides) Freckles are small, flat spots of concentrated melanin that are largely determined by genetics. They are most common in fair-skinned individuals and tend to darken with sun exposure and fade with reduced sun exposure over time.

Seborrhoeic Keratoses Seborrhoeic keratoses are benign growths that become more common with age. They can appear as brown, tan, or even darkened raised patches that may have a slightly waxy or rough texture. While not a true pigmentation disorder, they are often a cosmetic concern and can look similar to other pigmentation changes.

Vascular Pigmentation Some redness or discolouration of the skin is caused by superficial blood vessels rather than melanin. Conditions such as rosacea, broken capillaries, and certain birthmarks fall into this category and may respond differently to treatment than melanin-based pigmentation.

Hyperigmentation is influenced by a wide range of factors:

• Sun exposure is the single most significant contributing factor for most types of pigmentation. UV radiation directly stimulates melanin production and can trigger virtually all forms of hyperpigmentation.

• Hormonal changes associated with pregnancy, the contraceptive pill, or menopause are closely linked to melasma in particular.

• Skin inflammation or injury from acne, eczema, trauma, or certain skin procedures can trigger post-inflammatory hyperpigmentation.

• Genetics plays a role in how your skin produces and distributes melanin, and in your susceptibility to conditions such as freckles and melasma.

• Age is associated with reduced skin cell turnover and accumulated sun damage, making pigmentation more common and more persistent over time.

• Certain medications can increase sensitivity to light or directly influence melanin production as a side effect.

• Heat exposure, including from saunas, hot yoga, or repeated heat exposure to the face, can aggravate melasma in particular.

Most pigmentation concerns are benign and are primarily a cosmetic issue. However, it is important that any new, changing, or irregular skin lesion is assessed by a qualified healthcare professional before treatment is considered. Certain skin changes, including asymmetric spots, lesions with irregular borders, multiple colours, or any spot that bleeds, itches, or changes rapidly, should be reviewed promptly to exclude conditions such as melanoma.

At YourSkin Clinic, a clinical assessment by Dr. David Scott is always the first step before any treatment is recommended.

Treatment for pigmentation depends on the type, depth, and extent of the pigmentation, as well as your skin type, medical history, and individual circumstances. At our clinic, we offer a range of options that may be considered following a thorough assessment. These include laser treatments such as the Revlite SI and Varilight, as well as topical prescription and cosmeceutical preparations. In many cases, a combination approach across several of these modalities is considered as part of a broader treatment plan.

The Revlite SI is a Q-switched Nd:YAG laser that delivers precise, rapid pulses of light energy to targeted areas of the skin. The laser energy is absorbed by melanin within the skin, causing the pigmented cells to break down. The body then naturally clears the fragmented pigment through its lymphatic system over the weeks following treatment.

The Revlite SI operates across multiple wavelengths, which allows the treating practitioner to adjust the settings according to the depth and type of pigmentation being addressed. Its ability to deliver controlled energy with precision makes it a versatile option for a range of pigmentation concerns, including sun spots, freckles, and certain types of post-inflammatory hyperpigmentation.

Treatment with the Revlite SI is performed in-clinic. Most patients describe the sensation as similar to a rubber band flicking against the skin. The procedure is relatively quick depending on the area being treated, and there is generally minimal downtime. Some redness and darkening of the treated spots is expected in the days following treatment as part of the normal response process.